• Andrea Loggini, Valentina I Vasenina, Ali Mansour, Paramita Das, Peleg M Horowitz, Fernando D Goldenberg, Christopher Kramer, and Christos Lazaridis.
• Department of Neurology, Neurocritical care unit, University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave., MC 2030, 60637-1470 Chicago, IL, USA.
• J Crit Care. 2020 Apr 1; 56: 159-166.

PurposeThere has been a dramatic increase in penetrating gunshot-inflicted civilian penetrating brain injuries (cvPBI). We undertook a systematic review with exclusive focus on the management of cvPBI.MethodsWe explored: (1) cervical spine immobilization, (2) seizure incidence and prophylaxis, (3) infection incidence and antibiotic prophylaxis, (4) coagulopathy (5) vascular complications, and (6) surgical management. We searched PubMed, EMBASE, and Cochrane (1985-2019). The PRISMA guidelines were followed. The Newcastle-Ottawa Scale was employed for qualitative assessment; risk of bias was evaluated based upon the RTI item bank. The full protocol was registered to PROSPERO (CRD42019118877).ResultsThe literature is scant, and of overall low quality and high risk of bias. Incidence of c-spine injury with no direct trauma is low; incidence of seizures does not appear to be different from non-penetrating mechanisms; there is no robust data for prophylactic antibiotics; coagulopathy is prevalent and has been independently associated with outcome; there is a high incidence of vascular injuries with traumatic intracranial aneurysms the most common sequelae; neurosurgical decision-making appears largely influenced by operator's assessment of salvageability. Surgery has been associated with decreased mortality.ConclusionsLimited amount of published work is clinically meaningful; this systematic review identified key knowledge gaps.Copyright © 2019. Published by Elsevier Inc.

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